局部置换治疗股骨头坏死：初步报告
局部置换治疗股骨头坏死：初步报告
译者：罗殿中
背景：股骨头坏死的理想治疗方法尚未明确，本文报告了采用HemiCAPR股骨头局部置换治疗股骨头坏死的初步结果
方法：2011至2012年，共有4男1女5名患者，7侧髋关节诊断为股骨头坏死，年龄37至52岁，平均45.2±7.2岁，前期保守治疗无效、或前期手术失败，行股骨头局部置换手术。5名患者至少2年随访，1人左髋，2人右髋，2人双髋。手术采用髋关节外科脱位技术，股骨头弧度得到充分显露。植入与患者股骨头大小和弧度匹配的局部置换假体，无术中和术后并发症，无翻修手术。7例髋关节手术前和手术后2年的VAS评分和HHS髋关节评分均记录在案。
结果：随访24～33个月，平均26.6±3.8个月，术前VAS评分平均为8.9±0.9分，术后2年随访为2.3±1.0分，P=0.017。术后2年HHS髋关节评分改善至优良，86.0±7.9分，较术前较差评分26.7±11.8分，有显著性差异，P=0.018。VAS与HHS的临床评分具有良好相关性，P<0.05。
结论：本研究中，采用HemiCAPR股骨头局部置换治疗股骨头坏死的初步临床结果令人鼓舞，迄今为止，对股骨头局限性坏死性局部置换的临床结果，本文为首次报告。
图1. 术前X线片。骨盆前后位X线片显示双侧股骨头坏死。
图2. 术前MRI片，T1冠状位MRI扫描显示双侧股骨头坏死。
图3. 术中透视，术中透视显示内植物位置良好（HemiCAPR Arthrosurface, Franklin,MA）髋关节复位后，关节间隙良好；大转子截骨采用2枚4.5mm皮质骨螺钉固定。
图4. 术后X线片。48岁男性患者术后2年X线片显示，双髋内置假体无松动，关节间隙维持良好，因患者存在刺激性疼痛，取出了大转子螺钉。
Treatment of osteonecrosis of the femoral head with focal anatomic-resurfacing implantation (HemiCAP): preliminary results of an alternative option
Background: The optimal treatment of osteonecrosis of the femoral head has not been established yet. The aim of this study was to report preliminary clinical results of focal anatomic-resurfacing implantation for the treatment of osteonecrosis of the femoral head.
Methods: Five patients (four male, one female) with seven surgical procedures, ages between 37 and 52 with an average age of 45.2 ( /- 7.2), diagnosed as femoral head avascular necrosis and who were unresponsive to conservative management or had failed previous surgical treatments were treated with a focal anatomic femoral head resurfacing between the years 2011-2012 and were retrospectively reviewed. Five patients with at least two years of follow-up, one left hip, two right hips, and two patients with bilateral hip surgery were included in this review. After safe surgical dislocation of the hip, full exposure of the femoral head was established. A focal-resurfacing implant matching patient anatomy and femoral head curvature was performed accordingly. Neither intraoperative or postoperative complications nor revision ensued. Visual analogue scores and Harris Hip Scores were recorded both preoperatively and at postoperative 2 years for all seven surgeries.
Results: The mean follow-up period was 26.6 /- 3.8 months, with a range between 24-33 months. The mean visual analogue scores were 8.9 /- 0.9 preoperatively and 2.3 /- 1.0 postoperatively at year two (p = 0.017). Harris Hip Scores at postoperative follow-up were found to improve significantly from good to excellent scores (86.0 /- 7.9), compared with preoperative poor scores (26.7 /- 11.8) (p = 0.018). The clinical improvements in visual analogue scores (VAS) and Harris Hip Scores were also found to correlate with each other (p < 0.05).
Conclusions: In the present study, the alternative technique of focal anatomic hip resurfacing with HemiCAP® yielded preliminary successful results for the treatment of osteonecrosis of the femoral head. To the best of our knowledge, this is the first case series in the literature, reporting functional clinical results with the use of a focal anatomic-resurfacing implant for the treatment of focal femoral head osteonecrosis.
文献出处：Bilge O, Doral MN, Yel M, Karalezli N, Miniaci A. Treatment of osteonecrosis of the femoral head with focal anatomic-resurfacing implantation (HemiCAP): preliminary results of an alternative option. J Orthop Surg Res. 2015 Apr 28;10:56. doi: 10.1186/s13018-015-0199-3. PMID: 25924980; PMCID: PMC4423414.